Rural Health
Resources by Topic: Reimbursement and payment models
Emerging Strategies to Ensure Access to Health Care Services: Frontier Health System
Discusses the challenges of providing care in frontier communities and offers solutions for improving access to and delivery of care. Proposes the creation of a frontier-specific accountable care organization (ACO), the Frontier Health System (FHS), that provides traditional ACO services along with transportation, swing beds, home-based care, expanded visiting nurse services, and more.
Date: 11/2017
Sponsoring organization: American Hospital Association
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Discusses the challenges of providing care in frontier communities and offers solutions for improving access to and delivery of care. Proposes the creation of a frontier-specific accountable care organization (ACO), the Frontier Health System (FHS), that provides traditional ACO services along with transportation, swing beds, home-based care, expanded visiting nurse services, and more.
Date: 11/2017
Sponsoring organization: American Hospital Association
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Differences in Community Characteristics of Sole Community Hospitals
Findings brief presenting a snapshot of Sole Community Hospitals (SCHs) and their communities in 2015, and identifying trends in characteristics of selected SCHs and their communities from 2006 through 2015. Features statistics including breakdowns by large rural, small rural, and isolated rural location.
Author(s): Sharita R. Thomas, Mark Holmes, George H. Pink
Date: 11/2017
Sponsoring organization: North Carolina Rural Health Research Program
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Findings brief presenting a snapshot of Sole Community Hospitals (SCHs) and their communities in 2015, and identifying trends in characteristics of selected SCHs and their communities from 2006 through 2015. Features statistics including breakdowns by large rural, small rural, and isolated rural location.
Author(s): Sharita R. Thomas, Mark Holmes, George H. Pink
Date: 11/2017
Sponsoring organization: North Carolina Rural Health Research Program
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Using Telehealth to Identify and Manage Mental Health and Substance Use Disorder Conditions in Rural Areas
Reports on an environmental scan, discussions with providers and stakeholders, and site visits regarding how telehealth supports behavioral health and substance use disorder treatment. Addresses how telehealth is used, implementation, services offered, financing and sustainability. Focuses on the implications for treating opioid use disorders in rural areas, in particular, using medication-assisted treatment (MAT) with support from telehealth. Appendix B includes site briefs from the 9 states included in the study.
Date: 09/2017
Sponsoring organization: HHS Office of the Assistant Secretary for Planning and Evaluation
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Reports on an environmental scan, discussions with providers and stakeholders, and site visits regarding how telehealth supports behavioral health and substance use disorder treatment. Addresses how telehealth is used, implementation, services offered, financing and sustainability. Focuses on the implications for treating opioid use disorders in rural areas, in particular, using medication-assisted treatment (MAT) with support from telehealth. Appendix B includes site briefs from the 9 states included in the study.
Date: 09/2017
Sponsoring organization: HHS Office of the Assistant Secretary for Planning and Evaluation
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Medicare Inappropriately Paid Acute-Care Hospitals for Outpatient Services They Provided to Beneficiaries Who Were Inpatients of Other Facilities
Results of an audit to determine whether Medicare made payments appropriately to acute-care hospitals for outpatient services provided to other facilities' inpatients, from January 2013 through August 2016. Includes recommendations from the Office of Inspector General, and CMS's responses.
Additional links: Report in Brief
Author(s): Daniel R. Levinson
Date: 09/2017
Sponsoring organization: U.S. Department of Health and Human Services
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Results of an audit to determine whether Medicare made payments appropriately to acute-care hospitals for outpatient services provided to other facilities' inpatients, from January 2013 through August 2016. Includes recommendations from the Office of Inspector General, and CMS's responses.
Additional links: Report in Brief
Author(s): Daniel R. Levinson
Date: 09/2017
Sponsoring organization: U.S. Department of Health and Human Services
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Evaluation of the Minnesota Accountable Health Model
Describes the final results of Minnesota's State Innovation Model (SIM) initiative evaluation sponsored by the Centers for Medicare and Medicaid (CMS). Includes information on SIM investments in rural counties, considerations to strengthen and support infrastructure to advance integrated health partnerships in rural areas, and engagement strategies to include rural clinics and providers in Health Care Homes care coordination cost study.
Author(s): Donna Spencer, Christina Worrall, Emily Zylla, et al.
Date: 09/2017
Sponsoring organization: State Health Access Data Assistance Center
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Describes the final results of Minnesota's State Innovation Model (SIM) initiative evaluation sponsored by the Centers for Medicare and Medicaid (CMS). Includes information on SIM investments in rural counties, considerations to strengthen and support infrastructure to advance integrated health partnerships in rural areas, and engagement strategies to include rural clinics and providers in Health Care Homes care coordination cost study.
Author(s): Donna Spencer, Christina Worrall, Emily Zylla, et al.
Date: 09/2017
Sponsoring organization: State Health Access Data Assistance Center
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What is the Quality Payment Program?
Provides an overview of the Quality Payment Program (QPP) and its two associated payment tracks: the Merit-Based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (Advanced APMs). Describes how the QPP may affect rural practices and includes links to additional resources.
Date: 09/2017
Sponsoring organization: National Organization of State Offices of Rural Health
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Provides an overview of the Quality Payment Program (QPP) and its two associated payment tracks: the Merit-Based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (Advanced APMs). Describes how the QPP may affect rural practices and includes links to additional resources.
Date: 09/2017
Sponsoring organization: National Organization of State Offices of Rural Health
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Medicare Performance-Based Payment Adjustment Programs
Describes three Medicare Performance-Based Payment Adjustment programs for hospitals: the Hospital Acquired Condition Reduction Program (HACRP), the Hospital Readmission Reduction Program (HRRP), and the Hospital Value-Based Purchasing Program (HVBPP). Explains how these programs may affect rural hospitals.
Date: 09/2017
Sponsoring organization: National Organization of State Offices of Rural Health
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Describes three Medicare Performance-Based Payment Adjustment programs for hospitals: the Hospital Acquired Condition Reduction Program (HACRP), the Hospital Readmission Reduction Program (HRRP), and the Hospital Value-Based Purchasing Program (HVBPP). Explains how these programs may affect rural hospitals.
Date: 09/2017
Sponsoring organization: National Organization of State Offices of Rural Health
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MedPAC Report to the Congress: Regional Variation in Medicare Part A, Part B, and Part D Spending and Service Use
Compares Medicare spending and service use based on geographic location, including across metropolitan and nonmetropolitan areas. Seeks to identify factors that influence regional variation and determine if higher service use and/or spending results in higher quality care and outcomes. Utilizes updated data to build on findings that were published in the January 2011 Report to the Congress: Regional Variation in Medicare Service Use. Data is adjusted to account for differences in payment rates to certain providers, such as Critical Access Hospitals.
Date: 09/2017
Sponsoring organization: Medicare Payment Advisory Commission
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Compares Medicare spending and service use based on geographic location, including across metropolitan and nonmetropolitan areas. Seeks to identify factors that influence regional variation and determine if higher service use and/or spending results in higher quality care and outcomes. Utilizes updated data to build on findings that were published in the January 2011 Report to the Congress: Regional Variation in Medicare Service Use. Data is adjusted to account for differences in payment rates to certain providers, such as Critical Access Hospitals.
Date: 09/2017
Sponsoring organization: Medicare Payment Advisory Commission
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State Innovation Models (SIM) Initiative Evaluation: Model Test Year Three Annual Report
Third annual report detailing the findings of CMS's State Innovation Models (SIM) Initiative, which tests the ability of the governments in six states - Arkansas, Maine, Massachusetts, Minnesota, Oregon, and Vermont - to accelerate health system transformation in the areas of delivery systems, payment models, information technology, workforce development, and more. Focuses on sharing cross-state progress and findings, state-specific findings and lessons learned, and lessons for policymakers. Additional emphasis is placed on monitoring healthcare experience, utilization, and expenditures in participating SIM states.
Date: 09/2017
Sponsoring organizations: Centers for Medicare and Medicaid Services, RTI International
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Third annual report detailing the findings of CMS's State Innovation Models (SIM) Initiative, which tests the ability of the governments in six states - Arkansas, Maine, Massachusetts, Minnesota, Oregon, and Vermont - to accelerate health system transformation in the areas of delivery systems, payment models, information technology, workforce development, and more. Focuses on sharing cross-state progress and findings, state-specific findings and lessons learned, and lessons for policymakers. Additional emphasis is placed on monitoring healthcare experience, utilization, and expenditures in participating SIM states.
Date: 09/2017
Sponsoring organizations: Centers for Medicare and Medicaid Services, RTI International
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State Innovation Models (SIM) Round 2: Model Design Final Report
Shares results from a federal evaluation of the Round 2 State Innovation Models (SIM) Initiative awards, which focused on reforming payment and delivery systems, health information exchanges, workforce development, and sustainability. Provides a summary and review of each awardees' final State Health System Innovations Plan (SHSIP). Includes several suggestions and recommendations for improving rural healthcare delivery, payment, and access.
Author(s): Donald Nichols, Kathleen Farrell, Marisa Morrison, et al.
Date: 08/2017
Sponsoring organization: Centers for Medicare and Medicaid Services
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Shares results from a federal evaluation of the Round 2 State Innovation Models (SIM) Initiative awards, which focused on reforming payment and delivery systems, health information exchanges, workforce development, and sustainability. Provides a summary and review of each awardees' final State Health System Innovations Plan (SHSIP). Includes several suggestions and recommendations for improving rural healthcare delivery, payment, and access.
Author(s): Donald Nichols, Kathleen Farrell, Marisa Morrison, et al.
Date: 08/2017
Sponsoring organization: Centers for Medicare and Medicaid Services
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